How Iowa pays for disability services

Waiver inventory

Iowa has no autism-specific waiver and no 1915(k) Community First Choice option. ABA is a Medicaid state plan benefit.

State-only funded programs

None identified as an IDD-specific, state-only benefit with a separate appropriation.

What was checked: the Iowa HHS behavioral health and disability services FAQ, the HHS system alignment pages, the Legislative Services Agency briefing on Behavioral Health and Disability Services, the HHS fee schedule index, and the Disability Access Point award announcement.

What exists that is state-only but not IDD-specific: - Behavioral Health Service System (BHSS): statutory state appropriation of $42 per capita beginning FY 2025-2026, with future growth capped at 1.5% per year by the state growth factor. This replaced county levy funding and is behavioral health, not disability long-term services. legis.iowa.gov - Disability Access Points (DAPs): seven district-level contracts awarded February 2025, operational July 1, 2025, funded through HF 2673 state appropriations to the Division of Aging and Disability Services. Award amounts were not published in the announcement. hhs.iowa.gov - FY 2024-2025 one-time appropriation of $4 million to transition from MHDS to BHSS. legis.iowa.gov

County / regional / local funding

Iowa eliminated its county and regional disability funding stream. The history is the important part.

• Before July 1, 2012: counties contracted directly with community mental health centers using county funds and legislative appropriations.
• 2012 to June 30, 2021: 13 to 14 Mental Health and Disability Services (MHDS) regions, funded by county per capita property tax levies set by each region, with a statutory maximum of $47.28 per capita.
• July 1, 2021: the Legislature capped the county levy at $21.14 per capita, producing roughly $50.04 million statewide, and began backfilling with state dollars.
• FY 2022-2023 forward: county per capita levies for MHDS ended entirely. The state appropriated to HHS for distribution to regions at $38 per capita (FY 2022-2023), $40 per capita (FY 2023-2024), and $42 per capita (FY 2024-2025), distributed quarterly in proportion to each region's share of state population, with clawbacks if a region carried excess fund balance.
• July 1, 2025: Iowa Code chapter 225C was rescinded under HF 2673. The 13 MHDS regions ceased to be responsible for funding or managing services. Seven behavioral health districts replaced them, all overseen by a single administrative services organization (Iowa Primary Care Association, designated December 13, 2024). Disability services moved to the HHS Aging and Disability Services Division, delivered through Aging and Disability Resource Centers and seven Disability Access Points.
• Residual county obligations after July 1, 2025: maintaining FY 2025 and prior fiscal records and paying associated audit costs if the 28E entity dissolved, and appointing and compensating mental health advocates, reimbursable by the Behavioral Health ASO.

Sources: legis.iowa.gov hhs.iowa.gov hhs.iowa.gov

Funding scale

• ID waiver services, CMS-approved cost neutrality projection for waiver year 1 beginning January 1, 2026: $702,755,226.92 total, of which $557,560,458.95 is inside the managed care capitation and $145,194,767.97 is fee-for-service. Source: IA.0242.R07.02 Appendix J, medicaid.gov
• Spending per participant, ID waiver: Factor D of $47,547.71 for waiver year 1 (1/1/2026), rising to $53,571.61 by waiver year 5. Same source.
• Comparison institutional cost used in the same document: Factor G, the average ICF/IID cost, is $135,319.42 per person per year in waiver year 1. Same source.
• Largest single ID waiver service line, waiver year 1: Supported Community Living at $322,213,977.82, followed by Residential-Based Supported Community Living at $184,774,927.00 and Respite at $77,519,647.84. Same source.
• Number of people served in the ID waiver: 12,621 approved as of August 2026 against a CMS slot cap of 13,001, plus 1,207 applications in process. Source: hhs.iowa.gov
• Waiting list, ID waiver: 8,739 as of August 2026, up from 8,020 in January 2026. The "next application date for slot" was 7/7/2021, indicating roughly a five-year queue. Same source.
• Reserved capacity inside the ID waiver: 350 slots for ICF/ID and Money Follows the Person transitions, 72 slots for RBSCL. Same source.
• Iowa FMAP, FY 2026: 62.70%. State share of ID waiver services is therefore about 37.30%. Source: kff.org
• Total all-funds IDD/DD spending across all Iowa programs including ICF/IID, state resource centers, and non-waiver services: not found in a current published source.

Residential funding detail

Iowa funds four distinct residential models under the ID waiver, all excluding room and board per 42 CFR 441.310(a)(2).

1. Supported Community Living, daily (H2016 HI). Eight or more hours of support per day, billable up to 365 days per year. For the ID waiver this is paid at a fee schedule rate set for the member's acuity tier, not a single statewide rate. For the Brain Injury waiver the published daily upper limit is $565.02. Cannot be billed the same day as the 15-minute SCL unit.
2. Supported Community Living, 15-minute (H2015 HI). Upper limit $11.59 per 15 minutes. ID waiver members are capped at 20,440 units per year (Brain Injury waiver members at 11,315).
3. Residential-Based Supported Community Living, RBSCL (S5316 UA/UB/UC for adults, H2016 U3 for children). Paid per day at the fee schedule rate for the member's acuity tier. The CMS Appendix J average is $286.10 per day across 1,364 projected users in waiver year 1 (1/1/2026). RBSCL has its own reserved capacity of 72 slots inside the ID waiver.
4. Host home. Not a separate billing code. The host home provider is contracted by an SCL or Habilitation Home-Based Habilitation agency, which pays the host under contract and bills SCL or HBH. A written lease or residency agreement and a separate room and board agreement between the member and the host are required.

Payment structure. Iowa uses acuity-tiered per diems for the daily ID waiver residential and day services, layered on top of a legacy provider-specific transitional rate methodology. Tiered rates apply to daily SCL (H2016 HI), full-day Day Habilitation (T2020), full-day Adult Day Care (S5102), and children's RBSCL (H2016 U3). Tiers were originally set from each provider's historical reimbursement for affected members and communicated by individual letter from Iowa Medicaid, which is why the statewide rate table prints "See Published Fee Schedule" rather than a number for these codes. Fifteen-minute services (H2015 SCL, T2021 Day Habilitation, S5101 and S5100 Adult Day Care) are not tiered. Source: hhs.iowa.gov

Room and board. Not Medicaid-funded in any of these settings. It falls to the person's own income, principally SSI. A separate Iowa state supplement rate specifically for waiver residential settings was not located in this research.

Rate structure link: hhs.iowa.gov

Comparable service rates

Official rate schedule links

• HCBS Habilitation and Waiver Upper Rate Limits effective January 1, 2026: hhs.iowa.gov
• Iowa Medicaid Fee Schedules index: hhs.iowa.gov
• Open Fee Schedules search tool (published tiered rates by procedure code and modifier): secureapp.dhs.state.ia.us
• HCBS ID Waiver Tiered Rates FAQ: hhs.iowa.gov
• HCBS Waiver and Habilitation Billing Code Chart: hhs.iowa.gov
• Supported Community Living service overview: hhs.iowa.gov
• 2026 Monthly Slot and Waiting List Summary: hhs.iowa.gov

Notable features and flags

• July 1, 2025: Iowa Code chapter 225C rescinded under HF 2673. The 13 MHDS regions ended, seven behavioral health districts began under a single statewide administrative services organization, and disability services moved to the HHS Aging and Disability Services Division with seven Disability Access Points. County per capita levy funding for disability services is now fully gone. hhs.iowa.gov
• Waiver consolidation in progress: HHS is collapsing seven waivers into two, one for people under 21 and one for people 21 and older, each covering intellectual disability, brain injury, AIDS/HIV, physical disability, developmental disabilities, and either serious emotional disturbance or aging. Implementation began January 2025 and is expected to take several years. legis.iowa.gov
• August 20, 2025 public notice of technical amendments across seven 1915(c) waivers: Consumer Directed Attendant Care renamed Attendant Care; homemaker, chore, and companion consolidated into Home Maintenance Support; level of care tool for children ages 0 to 3 changed to interRAI-Early Years; Individual Support Broker made optional for self-directed participants; new requirement of face-to-face case manager contact at least every other month for people with intellectual or developmental disabilities. Stated fiscal impact: none. Comments closed September 19, 2025. hhs.iowa.gov
• ID waiver waiting list grew from 8,020 in January 2026 to 8,739 in August 2026, an increase of 719 in eight months, while approved enrollment rose only from 12,453 to 12,621. hhs.iowa.gov
• Rate increases have been incremental rather than structural: a 4.1% adjustment to provider rates in effect 6/30/2024 for many services effective 7/1/2024, and a 0.9% adjustment to Day Habilitation effective 8/1/2025. hhs.iowa.gov
• The HOME Project responds to a U.S. Department of Justice finding that Iowa was not in compliance with the ADA integration mandate regarding unnecessary institutionalization. iowaddcouncil.org and hhs.iowa.gov

Confidence

Solid: the ID waiver enrollment, slot cap, waiting list, and reserved capacity figures come directly from Iowa HHS's own monthly slot report updated August 7, 2026. The published upper rate limits, service units, and procedure codes come from the January 1, 2026 rate limits document. The cost neutrality totals, per-participant Factor D, and per-service projected volumes and unit costs come from the CMS-approved IA.0242.R07.02 application dated December 30, 2025. The county levy history and the per capita appropriation sequence come from the Legislative Services Agency briefing.

Estimated or indicative rather than definitive: the Appendix J unit costs are actuarial averages built for cost neutrality, not fee schedule rates, and for a few Iowa service lines the columns in the state's submission appear transposed, so I have used them only for residential and day per diems where they are internally consistent. Factor D is a projection for a waiver year that has just begun, not an actual expenditure.

Could not find: a published statewide table of the acuity-tier per diems for daily SCL, RBSCL, and full-day Day Habilitation. Iowa's tiers were derived from provider-specific historical reimbursement and communicated by letter, and the public route is the Open Fee Schedules lookup by code and modifier rather than a single downloadable table. Also not found: total all-funds Iowa IDD spending across waiver, ICF/IID, and state resource centers for FY 2025 or FY 2026; a state-only IDD-specific program with a discrete appropriation; and a current Iowa state supplement rate covering room and board in waiver residential settings.